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Fulltext A study of knowledge and attitudes towards contraception among health care staff in Kelantan (Malaysia)

Suhaimi H, Monga D, Siva A

Singapore Med J, 1996 Feb;37(1):51-4.
PMID: 8783914

OBJECTIVE: To study the knowledge, attitudes and practices on various contraceptive methods among all government health clinic staff in the state of Kelantan.
DESIGN: Questionnaire-based study.
SETTING: All government health clinics in the state of Kelantan which are health facilities located outside the general hospital and seven district hospitals.
SUBJECTS: All 711 nursing staff employed in government health clinics in Kelantan state (sisters, staff nurses, assistant nurses and midwives).
METHOD: Pretested, prestructured proforma was sent out to all the nursing staff employed in all peripheral health centres to be completed by them and returned the same day via the medical officer in charge of that district.
RESULTS: Most of the respondents were more than 30 years of age, married, multiparous and working for more than 5 years. Eighty to ninety percent practised contraception, with the majority of midwives preferring pills and the majority of staff nurses preferring condoms. Thirty to forty percent from all groups felt that folk methods are effective, and should be encouraged. Only about 50% of staff nurses are well informed on all contraceptive methods, but among assistant nurses and midwives, this figure is only 33%. A high proportion felt that the nursing curriculum deals inadequately with this subject.
CONCLUSION: The first step towards achieving success in our family planning programme lies in imparting more information to this target group of health workers, by incorporating more lectures during training and sending them for courses.
PIP: 711 government health clinic nursing staff in Kelantan state were surveyed about their knowledge, attitudes, and use of various contraceptive methods. 11 sisters, 122 staff nurses, 173 assistant nurses, and 334 midwives returned the questionnaire the same day of receipt. Most respondents were older than age 30 years, married, multiparous, and working for more than 5 years. 80-90% practiced contraception, with the majority of midwives preferring oral pills and the majority of staff nurses preferring condoms. 30-40% from each subgroup of respondents believed folk methods of contraception are effective and worthy of being encouraged. Approximately 50%, 33%, and 33% of staff nurses, assistant nurses, and midwives, respectively, were well informed on all contraceptive methods. A high proportion of staff felt that the nursing curriculum fails to adequately address the subject. The authors stress that in order to realize success in the family planning program, more information must first be imparted to these health personnel. To that end, more lectures could be provided during training, followed by frequent and thorough refresher courses for all nursing staff.
Fulltext Treatment of MOG antibody associated disorders: results of an international survey

Whittam DH, Karthikeayan V, Gibbons E, Kneen R, Chandratre S, Ciccarelli O, et al.

J Neurol, 2020 Dec;267(12):3565-3577.
PMID: 32623595 DOI: 10.1007/s00415-020-10026-y

INTRODUCTION: While monophasic and relapsing forms of myelin oligodendrocyte glycoprotein antibody associated disorders (MOGAD) are increasingly diagnosed world-wide, consensus on management is yet to be developed.
OBJECTIVE: To survey the current global clinical practice of clinicians treating MOGAD.
METHOD: Neurologists worldwide with expertise in treating MOGAD participated in an online survey (February-April 2019).
RESULTS: Fifty-two responses were received (response rate 60.5%) from 86 invited experts, comprising adult (78.8%, 41/52) and paediatric (21.2%, 11/52) neurologists in 22 countries. All treat acute attacks with high dose corticosteroids. If recovery is incomplete, 71.2% (37/52) proceed next to plasma exchange (PE). 45.5% (5/11) of paediatric neurologists use IV immunoglobulin (IVIg) in preference to PE. Following an acute attack, 55.8% (29/52) of respondents typically continue corticosteroids for ≥ 3 months; though less commonly when treating children. After an index event, 60% (31/51) usually start steroid-sparing maintenance therapy (MT); after ≥ 2 attacks 92.3% (48/52) would start MT. Repeat MOG antibody status is used by 52.9% (27/51) to help decide on MT initiation. Commonly used first line MTs in adults are azathioprine (30.8%, 16/52), mycophenolate mofetil (25.0%, 13/52) and rituximab (17.3%, 9/52). In children, IVIg is the preferred first line MT (54.5%; 6/11). Treatment response is monitored by MRI (53.8%; 28/52), optical coherence tomography (23.1%; 12/52) and MOG antibody titres (36.5%; 19/52). Regardless of monitoring results, 25.0% (13/52) would not stop MT.
CONCLUSION: Current treatment of MOGAD is highly variable, indicating a need for consensus-based treatment guidelines, while awaiting definitive clinical trials.
Diagnosis and classification of optic neuritis

Petzold A, Fraser CL, Abegg M, Alroughani R, Alshowaeir D, Alvarenga R, et al.

Lancet Neurol, 2022 Dec;21(12):1120-1134.
PMID: 36179757 DOI: 10.1016/S1474-4422(22)00200-9

There is no consensus regarding the classification of optic neuritis, and precise diagnostic criteria are not available. This reality means that the diagnosis of disorders that have optic neuritis as the first manifestation can be challenging. Accurate diagnosis of optic neuritis at presentation can facilitate the timely treatment of individuals with multiple sclerosis, neuromyelitis optica spectrum disorder, or myelin oligodendrocyte glycoprotein antibody-associated disease. Epidemiological data show that, cumulatively, optic neuritis is most frequently caused by many conditions other than multiple sclerosis. Worldwide, the cause and management of optic neuritis varies with geographical location, treatment availability, and ethnic background. We have developed diagnostic criteria for optic neuritis and a classification of optic neuritis subgroups. Our diagnostic criteria are based on clinical features that permit a diagnosis of possible optic neuritis; further paraclinical tests, utilising brain, orbital, and retinal imaging, together with antibody and other protein biomarker data, can lead to a diagnosis of definite optic neuritis. Paraclinical tests can also be applied retrospectively on stored samples and historical brain or retinal scans, which will be useful for future validation studies. Our criteria have the potential to reduce the risk of misdiagnosis, provide information on optic neuritis disease course that can guide future treatment trial design, and enable physicians to judge the likelihood of a need for long-term pharmacological management, which might differ according to optic neuritis subgroups.

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